Provider Demographics
NPI:1891803300
Name:NORTHWEST ANESTHESIA PC
Entity Type:Organization
Organization Name:NORTHWEST ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GOC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-778-9738
Mailing Address - Street 1:PO BOX 31668
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-0668
Mailing Address - Country:US
Mailing Address - Phone:402-778-9738
Mailing Address - Fax:402-334-6833
Practice Address - Street 1:6901 N 72 STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122
Practice Address - Country:US
Practice Address - Phone:402-572-2160
Practice Address - Fax:402-334-2849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE207L00000X, 367500000X
IA207L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0597096Medicaid
IA0949701Medicaid
IAI21224Medicare PIN